O Tempora, O Mores: Affordable Care Act - Big Dream or Big Let Down?

I confess I was a strong proponent of the Affordable Care Act. My reasoning was subtler than the hallowed pantheons of its staunch supporters and the apocalyptic predictions of its detractors. Forty years after graduating medical school I concluded, after many stutter steps, the American healthcare delivery system was economically unsustainable and the citizenry was neither living longer, nor better, despite medical expenditures that dwarf any other developed nation. My career also allowed me to personally interact with cardiac surgeons from all continents and see that their clinical results and research efforts were laudatory by any standards.

It pained me to see the counterproductive hurling of inaccurate, invective, and promulgating fear and misinformation based on political ideology with no regard for attempting to confront the problems of the status quo. Obamacare is not, in fact, a revolutionary change in healthcare delivery; it is health insurance reform with a mandate for universal coverage that on the fringes promotes new reimbursement models, but mostly preserves, at present, a fee-for-service system.

What was potentially the most beneficial aspect was that a political third rail had been breached-- the medical-industrial complex was confronted and legislation was passed and judicially approved. Obviously the law was tainted, imperfect and inexpertly introduced. I was naive and felt it was a start; the first step had been taken and now we could start the process of actually improving healthcare delivery to everyone because it was now a premise that all were entitled to.

As Cicero so aptly lamented during his first Catalonian Oration, “O Tempora, O Mores;” what difficult times, how unethical the political climate. I still do not get my facts from viewing the Republican Presidential Debates, nor sound bites from right-wing talk radio. To the chagrin of my GOP friends, I subscribe to and read daily the New York Times. Two recent articles from the fountain of liberal mantras suggest that the Affordable Care Act is not working and this attempt at reform maybe significantly flawed. Our present administration may be more interested in painting rosy pictures than facing uncomfortable economic reality.

On January 6, 2016, the front page headline was “Medical Debt Often Crushing Even for the Insured”. Despite coverage by Obamacare, 20% of people too young for Medicare eligibility had having trouble paying their medical bills last year. They are still vulnerable because of the rising cost of coverage and covering 15,000,000 more Americans has accelerated the burden of copays and deductibles. That take-home message was reiterated and anecdoted over the rest of the 1/2-page article and a week later the headline was about costs climbing as more people enroll past the health act set deadline.

The administration is focused on the metric of increasing the number of enrollees; therefore, it has allowed large numbers of people to sign up past the deadline by creating “special categories” or “new onset circumstances” as a humanitarian response. However, once the medical emergency is over, these folks drop out after a temporary subsidization. These temporary riders, so to speak, are, according to insurers, harming and destabilizing the exchange markets. The Feds set up these post-deadline circumstances for eligibility, but provided no support, nor guidance, to verify that this cohort actually qualified.

Behind the ideological sniping, there is accumulating more and more evidence that the economic premise of universal coverage, i.e. large pools of insured made up of multitudes of the young and healthy to offset the older and sicker, and efforts to eliminate waste and fraud, may not be attainable as this bill is implemented. Where is the political will and expertise to be found to fix it?

By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton

Build Your List of Potential Investors, Pitch Investors Properly, How Kevin Systrom Raised $500,000 in Two Weeks to Launch InstagramFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 12

Most startups need funding at some point. Once you have the addressed all of the items in the previous episodes, it is time to build your list of potential investors and start the conversations. They can be friends, family, social network, social media contacts, work colleagues, people in the business industry, etc. Try to put together a list of at least one hundred people. A list of one hundred potential investors may seems like a lot, but the more people you have on the list, the better your chances are of success.

Making Money With Your Business, Profit and Cash Flow, Five Sustainable Companies That Make a Lot of MoneyFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 10

It is time to make money! You have been through a couple of rounds of market testing now you feel like you are on to something. The next step is to run the numbers to make sure that the business is sustainable. There are two sides to making money, profitability and cash flow.

Why Competition Is Good For Entrepreneurs and How Blockbuster’s $50 Million Mistake Helped Reed Hastings and Netflix Destroy a $6 Billion Empire Find Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Epis

When battling for resources or investment, early-stage entrepreneurs may believe that competition is a bad thing. On the surface, they are correct. There are a limited number of angel investors willing to provide a finite amount of venture capital to founders.

Upscaling and Scaling Business Ideas into Reality – Jeff Bezos takes Amazon from Online Bookstore to Global DominanceFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 4

Congratulations, your market testing worked and you were able to find customers, or at least one customer. Your beta test was successful and you are confident that you are ready for more. What do you do when you start getting customers or users? I recommend you do some scaling or upscaling.

What Kind of Business Should You Start? – How Mark Zuckerberg Pivoted From Rating Hotness to FacebookFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 1

When it comes to brainstorming startup ideas, new entrepreneurs and even seasoned ones scratch their heads in confusion. Living in the information age, you can scan the current market and see countless new business ideas. With so many options out there, how do you know which one is right for you?

Why Would a Doctor Abandon a Steady Paycheck to Become an Entrepreneur?

As physicians, we are expected to be compliant with rules, restrictions, and regulations. We are expected to be risk averse. We are expected to be “providers,” but not necessarily innovators or leaders. As the healthcare system becomes increasingly consolidated into large overcrowded clinics, we are required to perform to the standards set by bureaucrats and clinic managers. These rules are often at odds with the best interests of patients and with our sanity.

The Alienation Of America’s Best Doctors

The best and the brightest simply don’t want to become doctors anymore. Physicians are burning out. They are leaving the profession. They are going bankrupt. They are selling their private practices to big hospitals. They are retiring early. We are facing a growing doctor shortage.

Better to Live and Die in the U.S.A.

The United States healthcare system is often berated for how it treats patients near the end of life. They are purportedly attached to tubes and machines and subjected to unnecessary invasive procedures that cause inordinate pain with no potential benefit, there is underutilization of more compassionate hospice services. This “travesty” is expensive, as the care of dying seniors consumes over 25% of Medicare expenditures. We hear this story so often; it is almost taken as gospel-- but is it actually true? Is it more expensive and invasive to die in America than in other developed countries?
Page: 1234 - All